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MHC class 1 do not require CD4 expressing lymphocytes: the other lymphocytes (NK, C8) will suffice.

If you have been exposed to a MHC class 2 (or one of your commensal MHC class 2 reactivates)(could be any minor thing that you even have not noticed), the nearby 100 CD4s will clone themselves thousands or even million folds to mount the counter attack (think of Starwars). If 1 of the initial CD4s still carry some latent virus RNA, then all sudden they are thousands.

They are disposable infantry. Once the attack is over, they die. and as they die, they leave some VL behind them.

That's is what your test picks up.

If your treatment is successfull and you are adherent, then there is no way this free flying RNA can re-infect other cells

So after my first blip in June, I had another round of labs done in August, and VL came back undetectable.

But then in November I had follow up labs done and today got the results: viral load of 80...wtf....my doctor is stumped, and does not know what to make of it.

He says this is not an indication of treatment failure yet, and is not really concerned, and just wants to see me in four months.

So to summarize:

June: 100 VLAugust: undetectableNovember: 80 VL

I know there really is always very low level viral replication going on regardless of succesful treatment, or as Eric48 posted, this could just be dying cells releasing virus particles. But I'm stumped on this one, and I was wondering if this scenario is familiar to others.

As yes, I know I can count on having many blips down the line, but what are the thoughts about these two blips being a few months apart, but separated by an undetectable??

Thanks in advance, J.

Logged

"Hope is my philosophy Just needs days in which to beLove of Life means hope for meBorn on a New Day" - John David

that is not really true. While you might see small jumps (<300) in your counts - as HIV is never 100% eradicated - blips (which are usually > 1000) are usually quite rare. If you stay adherent to your medication so that no resistance is allowed to happen, blips should never occur as the virus is always kept in check

He says this is not an indication of treatment failure yet, and is not really concerned, and just wants to see me in four months.

think back real hard without putting your spin on things. Was your doctor truly "stumped" or was he "not really concerned"? As your "blipette" wasn't even approaching 1000, I'd bet money that your doctor was not really concerned. If he doesn't want you back for blood work for another 1/3 of a year, he can't be all that concerned.

Of course, any smallish rise in CD4 count is apt to make a doctor question your adherence. Less than 25% of all HIV positive people in America remain in proper therapy and undetectable - so it's pretty common for doctors to be looking for the slightest hint of patient adherence failure.

Logged

leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

Of course, any smallish rise in CD4 count is apt to make a doctor question your adherence. Less than 25% of all HIV positive people in America remain in proper therapy and undetectable - so it's pretty common for doctors to be looking for the slightest hint of patient adherence failure.

For the benefit of the newbies, Mike meant to say "Of course, any smallish rise in VIRAL LOAD is apt to make a doctor question your adherence."

Sometime in this past year, my doctor and I had a long talk about a study he is currently conducting. (He's an hiv pharmacologist who does a lot of research in conjunction with the University of Liverpool and also is also responsible for the http://www.hiv-druginteractions.org/ website.)

Basically, the study is looking at the CNS fluid of people who have repeated, low level VL blips. The theory behind the study is that if the meds you're taking aren't crossing the blood/brain barrier in sufficient quantities (or at all), this means there is constant viral replication going on in this particular hiv reservoir. (Keep in mind there are other reservoirs where the VL is much more difficult to measure.)

The theory goes on to speculate that occasionally, the virus is "spilling over" from the reservoir (in this case the brain and CNS fluid) into the blood stream and that is what is causing the detectable "blips".

When this "spill over" occurs, the meds readily available in the blood stream quickly bring the VL back down to UD.

There are details of this study somewhere online, but I don't seem to have bookmarked the page. If anyone is interested (it's just study criteria and protocol, no results yet) I'll try to dig it out.

I only know about this study because my partner took part in it this spring. I spoke in depth about it with our doctor because the language of the study protocol worried me (it talked about "persistent viral load") and I wanted to know what the hell was going on - if he had a persistent VL, why weren't they changing his meds instead of using him as a guinea pig? Turns out they were talking about blips, not a constant detectable VL. Whew!

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

For the benefit of the newbies, Mike meant to say "Of course, any smallish rise in VIRAL LOAD is apt to make a doctor question your adherence."

oops! Thanks for the catch! Obviously my fingers weren't listening to what my brain was saying as I was typing

and another oops too. It's 28% that remain in care and undetectable. 28%, 25% I was still close because 28% is closer to a quarter than a third. Either way it's very troubling for treatment, for transmission suppression, for future funding, for people's health - and no wonder doctors may be wary of any blips or blipettes

Logged

leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix